Provider Demographics
NPI:1942849302
Name:JACOBS, JULIE ANN (MOT OTR)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MOT OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 SANTA FE BLVD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4059
Mailing Address - Country:US
Mailing Address - Phone:765-271-2070
Mailing Address - Fax:
Practice Address - Street 1:504 SANTA FE BLVD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4059
Practice Address - Country:US
Practice Address - Phone:765-271-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist